Stopping healthcare fraud must be public policy key

The vast landscape of scamming in government programs is always discouraging — the drive of cheaters to skim dollars off of any large pot of public money appears relentless. But honest people like Cathy Bell remind us that some care about what’s right, even when it doesn’t benefit them.

When the Northwest Side woman discovered a box full of unwanted medical aids in her mom’s home, Bell could have tossed them. She might even have made a few bucks selling them online. Her 84-year-old mother, Nancy DeLozier, never asked for them and didn’t knowingly order them; orders were placed on her behalf by medical opportunists. They cold-called her, asked her about any pain she might be having and passed on the information to a third-party doctor who prescribed equipment such as back and knee braces, a shoulder-support device and ankle and wrist braces.

They told DeLozier the equipment was “free” and it was, to her. But, through Medicare, taxpayers paid more than $3,800 for the stuff — some of which could be purchased through retail sites at a fraction of what the opportunists billed the federal health-care program for the elderly.

Rather than shrug and get rid of it, Bell got mad. Through hours spent on the phone with government bureaucrats, medical-device suppliers and at least one prescribing physician, Bell has recovered $1,200 for Medicare.

She ought to get a medal, even if that is but a drop in the bucket of this particular variety of health-care fraud.

A recent Dispatch story revealed how Columbus city taxpayers were soaked by a similar scam. A loophole in the city’s medical coverage for firefighters and police officers allowed compound drugs — those mixed onsite at a pharmacy — to be covered without prior approval from the insurance carrier.

Those in a position to take advantage apparently got word quickly; within two months of the contract taking effect, pharmaceutical salespeople began showing up at police stations and firehouses, pitching a great new cream to ease aches and pains and make skin look better — at no cost to employees.

Unethical doctors prescribed the cream for those interested and unethical pharmacies billed the city’s insurer more than $8,000 per prescription for a cream composed of nonprescription ingredients available at stores for about $60. In five months, $6 million in compounddrug prescriptions were billed to the city’s insurer. Under the prior contract, such costs were less than $200,000.

To most people — those who don’t view public money as theirs to creatively plunder — the scale and sheer industriousness of such fraud is stunning.

Experts estimate that $60 billion to $90 billion of Medicare spending — 10 percent or more of the budget — goes to fraud. The $8,000-cream episode shows that cityfunded insurance can be just as vulnerable.

Unfortunately, most people don’t react to being used in a scam as fiercely as Bell did. “I just think it’s incredibly wrong, just on a moral level,” she said. She also takes a wisely long view: “I’d like to have Medicare benefits when I need it. Medicare is in trouble, and this is just adding to the problem.”

As policymakers wrestle with how to make sure Americans have access to health care, stamping out scams should be among the top priorities.